Dissociative Identity Disorder (DID) – formerly known as Multiple Personality Disorder – is a relatively common psychiatric disorder that may affect 1-3% of the general population. DID is characterized by a significant disruption of a unified sense of self and continuity of experience, exemplified by two or more personality/identity/self states. In some cultures, this disruption of a unified sense of self may be understood as an experience of possession that is not considered congruent with that culture’s spiritual/religious practices.
In addition, individuals with DID experience Dissociative Amnesia (DA): a disruption in memory for important personal information, as well as for current and past personal experience, that is inconsistent with ordinary memory problems.
This significant disruption in a unified sense of self and memory can occur in a number of ways that include hard to explain disturbances and/or variability in:
- Bodily sensations or functioning
These disruptions and alterations cannot be better explained by the effects of alcohol or drugs, or a medical or brain disorder, such as epileptic seizures. These symptoms must cause significant problems with functioning.
Unlike portrayals in the media, the “fascinating”, stereotyped external characteristics of DID self states, such as different names, voice tone, accents, wardrobe, hair-styles, handwriting, and more, are not essential for diagnosis and are secondary factors to the core phenomena of DID.
The diagnostic criteria for DID mean that there are two or more relatively separate centers of information processing in the mind. Each information processing center in the mind is characterized by:
- A sense of personal identity
- A self-image
- A set of (state dependent) autobiographical memories
- A sense of ownership of personal experience
- Capacity to control/enact behavior
These self states may shift, switch, or overlap in a number of ways that lead to the disruption in self and continuity of experience in DID.
The individual’s personality/identity/self states are NOT separate people. These are subjective states of the individual’s mind. All of the DID states together make up the whole person and that person’s total personality.
Because of this, and unlike descriptions in the popular media, the individual with DID as a whole person is held responsible for behavior, even if experienced with amnesia or a sense of lack of control over one’s actions.
The Development of Dissociative Identity Disorder
Individuals with DID report the highest rates of childhood trauma, particularly physical, sexual, and emotional abuse – generally beginning before the age of six – of patients with any psychiatric disorder. Because of this, DID can be conceptualized as a childhood onset, posttraumatic developmental disorder in which the traumatized child is unable to complete the normal developmental processes involved in consolidating a core sense of self. Together with disturbed caretaker-child attachment and parenting, repeated early trauma disrupts the development of normal processes involved in the elaboration and consolidation of a unified sense of self. Therefore, the child fails to integrate the different experiences of self that normally occur across different states and contexts.
DID has been found in children, adolescents, and adults. Unfortunately, early trauma may be a risk factor for later trauma. DID individuals report very high rates of adult rape, intimate partner violence, and other forms of exploitation, such as being a victim of trafficking.
DID is both a disorder and a form of resilience. Psychological compartmentalization of traumatic/overwhelming experiences allows for more normal development of the capacity for clear thinking, intellectual and creative abilities, the ability to understand reality, development of a sense of humor, the capability for attachment to others, and a capacity for insight – all important in the psychotherapy treatment of DID.
Symptoms of Dissociative Identity Disorder (DID)
The posttraumatic origins of DID mean that anywhere between 80 and 100% of individuals with DID who receive treatment also have symptoms of posttraumatic stress disorder (PTSD - see section on PTSD). Other disorders commonly associated with DID are depression or very rapid “mood swings” that frequently do not (or only very partially) respond to medications; substance abuse; and unexplained medical symptoms with repeated “negative” work ups, typically for apparent seizures or other neurological disorders.
One of the most common symptoms of DID is hearing voices, most often within the mind. Because of this, many individuals with DID are unsuccessfully treated with medications for schizophrenia or other psychotic disorders (see section on psychotic disorders).
Individuals with DID have very high rates of self-destructive and suicidal behavior and often have multiple, usually unproductive, hospitalizations for mood disorders, personality disorders, and/or psychotic diagnoses. The average individual with DID spends five to 12.5 years in mental health treatment until a correct diagnosis is made.
Having suicidal or self-destructive thoughts, impulses, urges, plans or behavior require emergency treatment, including calling 911 or going to the nearest Emergency Department or Mental Health Urgent Care Clinic.
A diagnosis of dissociative identity disorder should be suspected if you or your loved one:
- Receives numerous different psychiatric diagnoses, yet does not respond to many different types of treatments including multiple medications, types of psychotherapy, or neurostimulation treatments like electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Unlike the stereotype of DID, symptoms of DID are usually subtle and hidden, and individuals with DID do not readily reveal their symptoms without careful examination by a mental health professional.
You or your loved ones may notice the person is:
- Repeatedly very “moody”
- Highly changeable from time to time, and
- Has difficulty recalling important personal experiences.
- This can include a variety of current behaviors and parts of the life history, that are not related to use of substances or medications, or to brain injuries or diseases.
These difficulties recalling important personal experiences can include:
- Significant gaps in memory for life history
- Experiencing “black outs” or “time loss”: gaps in remembering current life history
- Lack of recall of complex, witnessed behaviors – even positive behaviors, such as doing well in a presentation at work
- Not remembering or difficulty remembering important events, such as graduations, birthdays, weddings, and vacations, that other family members recall well
- Recurring puzzling lack of memory for things that the person has purchased or created
- Inexplicable alterations in abilities and habits, such as forgetting that one can play a musical instrument, or changing suddenly from a smoker to a non-smoker, then back again
- Repeated unexplained travel or “getting lost” in familiar places
- Repeated rationalizations for being “forgetful” or “preoccupied”
Other common symptoms of DID include:
- Hearing voices, particularly inside one’s mind; these are often experienced as having their own sense of self, such as a child’s voice, an angry voice, a caring and supportive voice, among others
- Seeing things that others do not see, such as people, faces, or visions, including seeing the “people” that one is hearing talking
- Out of body experiences, as if watching oneself from a distance outside, or even inside oneself, frequently accompanied by the feeling that one can observe, but not control what one is doing
- Feeling like you are disconnected from the world around you as if seeing through a fog; things seem unreal
- Experiencing repeated inexplicable, sudden intrusions of thoughts, feelings, urges, or actions that one does not control
- Experiencing repeated inexplicable, sudden deletion of thoughts, feelings, behavior that one does not control
- Feeling divided with different senses of self that seem relatively independent of one another, and often are in a conflict or a struggle
- Inexplicably feeling very different at different times with varying opinions, abilities, habits, and access to memory and learned information
Treatment of Dissociative Identity Disorder
DID is a treatable disorder once it is properly diagnosed. Clinicians who understand DID symptoms can diagnose DID in the clinical interview. There are also paper and pencil tests that can help clinicians diagnose DID and other dissociative disorders.
Studies show that DID symptoms improve over time when treated using Phasic Trauma Treatment.
Phasic Trauma Treatment
Phasic trauma treatment is a psychotherapeutic treatment that has three phases:
- Safety and stability
- Work on traumatic memories
- Re-integration into life
In DID treatment, working directly with the DID identities is crucial to diminish symptoms and to maximize the resilience found in most people with DID. The first phase, safety and stability, is the most important. During this phase, individuals learn how to stabilize symptoms of DID and PTSD, using a variety of psychotherapeutic techniques and sometimes adjunctive/add-on medications.
It is critical for the individual with DID to develop safety from suicidal and self-destructive behaviors, substance abuse, eating disorders, high risk behaviors, unsafe people, and other dangerous behaviors and situations. This is because DID develops in a childhood environment of repeated lack of safety and unpredictable danger.
Without development of safety, DID treatment will not progress.
Not all individuals with DID wish to address his/her traumatic experiences in depth. However, if the individual with DID agrees, and has achieved safety and stability, Phase 2 is focused more on carefully and slowly recalling the life history – which is often experienced as PTSD flashbacks. Therefore, this phase also involves ongoing work on safety and additional stabilization of DID and PTSD symptoms.
In Phase 3, the individual’s DID and PTSD symptoms have usually substantially moderated, and the individual with DID may even experience subjective fusion of some or all self states, with complete merging of the characteristics of these subjective identities. This frees up energy for a focus on living better in the present.
Adjunctive/Add-On Treatments for Dissociative Identity Disorder
Hypnotherapy: Hypnotherapy can be helpful in stabilizing DID and PTSD symptoms. However, hypnotherapy can only be used if the therapist has received certification in using hypnosis and has specialized training in its use in DID and other posttraumatic disorders. Make sure to ask your provider about his/her credentials in using hypnosis.
Medications: Medications are adjunctive (add-on) treatments in DID treatment and do not directly affect the basic symptoms of DID. In DID treatment, medications do not have a major direct effect on symptoms unless there are other specific disorders present. For example, there are medications that can substantially improve symptoms of PTSD, although some people cannot take these due to side effects.
Medications for depression and mood symptoms usually have limited effects, but may provide some symptom relief as long as the patient and practitioner have carefully identified which symptoms will and will not be helped by medications. Medications for anxiety symptoms can be moderately helpful but must be monitored carefully, especially in individuals with a history of substance abuse.
Individuals with DID often have a complex, chronic sleep disturbance with difficulty falling asleep, staying asleep, nightmares, and even complex behaviors that appear to emerge out of sleep. There are medications that can help PTSD nightmares and this may improve sleep, if the patient does not have problematic side effects. Sedating medications often are only partially helpful. Specific DID psychotherapy is often required to assist with fears and flashbacks related to bed, night, and sleep, and nighttime dissociative symptoms.
Other Types of Psychotherapy that can Assist with DID Treatment
Other forms of psychotherapy such as dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) that is focused on trauma-related cognitive distortions can be helpful as adjunctive/add-on to the phasic psychotherapy for DID.
Eye-Movement Desensitization and Reprocessing Therapy (EMDR): Eye-movement Desensitization and Reprocessing Therapy (EMDR) is a treatment that has been found to improve PTSD symptoms, typically in people who have experienced specific adult traumas.
EMDR can significantly worsen the symptoms of DID, especially if used before the DID patient is stabilized in treatment. EMDR can be an adjunctive/add-on treatment if the therapist has full training in EMDR and has specialized training in its use in DID and other complex posttraumatic disorders.
Group Therapy: Group therapy can be helpful for the stabilization of individuals with DID if they are in a group dedicated to patients with this diagnosis, and the group is facilitated by practitioners that are knowledgeable about DID treatment. Individuals with DID usually do not do well in general therapy groups, even those that focus on PTSD and trauma, but are not designed for severely dissociative patients.
In general, DID experts do NOT recommend the use of non-professionally facilitated support groups in the treatment of DID, including online support groups. Both in-person and online “support” groups ultimately may have a severely negative impact on the individual with DID and his/her treatment.
Family Involvement: Family treatment, usually with the patient’s spouse, or significant other can be helpful, for education and to help support both the patient and the family during an often long and difficult treatment. In particular, family members are educated to not directly interact with the patient’s varying self states, but should regard their partner as a “whole human being,” and not a group of separate “people.” Specialized couple’s therapy may be helpful if the therapist is knowledgeable about treatment of childhood trauma and its impact on adult relationships.
Rehabilitation Therapies: Adjunctive/add-on rehabilitation therapies like art therapy and occupational therapy can be helpful if the therapist has training in the use of these modalities in the treatment of complex posttraumatic disorders like DID.
To learn more about dissociative identity disorder, visit The Trauma Disorders Program's section of our website and the International Society for the Study of Trauma and Dissociation's website.
Do DID alters share knowledge? ›
Patients with Dissociative Identity Disorder do remember separate identities. People with Dissociative Identity Disorder (DID) are able to exchange information among their separate identities.Is Osdd part of DID? ›
Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1).Do people with DID remember what they DID? ›
You might find that your behaviour changes depending on which identity has control. You might also have some difficulty remembering things that have happened as you switch between identities. Some people with DID are aware of their different identities, while others are not.Is there science behind DID? ›
Attachment theory allows the cause of DID to be traced even further back to neurodevelopment that occurs during infancy. The combination of disorganized attachment with later childhood trauma provides a strong basis for the development of DID.Do alters have the hosts memories? ›
Alters usually do not have access to memories of happenings when they are not in control of the body. It can thus be a challenge to keep up with what the body is going through at any point of time.Are multiple personalities aware of each other? ›
In some cases all of the personalities remain mutually unaware of the others' existence. In a more common form of the disorder, there is one personality that basically dominates the person's conscious awareness.Is OSDD less severe than DID? ›
OSDD: a matter of degree? In terms of other differences, it seems that as a general rule the degree of the trauma or attachment difficulties leading to OSDD will be less severe than people who are diagnosed with dissociative identity disorder, especially polyfragmented dissociative identity disorder.Is split personality the same as DID? ›
A split personality is a popular term for DID. In the past, DID was known as multiple personality disorder. People with DID have two or more distinct personalities. They do not present as simple changes in traits or moods.How can you tell the difference between DID and OSDD? ›
Differentiating Between Dissociative Identity Disorder and Other Specified Dissociative Disorder. Some people with OSDD have two or more distinct personality states, or alters, but don't experience any gaps in memory or amnesia, a necessary symptom for a DID diagnosis.What does switching feel like DID? ›
Some indicators that a switch may be about to occur include the following: feeling "spacey", depersonalized, or derealized; blurred vision; feeling distanced or slowed down; feeling an alter's presence; or feeling like time is beginning to jump (indicating minor episodes of time loss).
Do people with DID have false memories? ›
Even supposedly factual reporting can present people with dissociative identity disorder as untrustworthy and prone to wild fantasies and false memories. But research hasn't found people with the disorder are more prone to “false memories” than others.Do people with DID have emotions? ›
Overall, the data suggest that individuals who report dissociative experiences initially engage emotional information but have negative personal attributions about many emotional thoughts and also tend to devalue their own mental faculties (as shown by dysexecutive scale elevations).Can you intentionally develop DID? ›
Why You Can't Give Yourself DID. Having DID was not a conscious decision those of us with the disorder made when we were children. Dissociative identity disorder is not a selective disorder, meaning you cannot decide that you want to develop this brilliant coping mechanism and then you have it.What is the root cause of DID? ›
The main cause of DID is believed to be severe and prolonged trauma experienced during childhood, including emotional, physical or sexual abuse.Can DID be reversed? ›
Will dissociative identity disorder (DID) go away? There is no cure for DID. Most people will manage the disorder for the rest of their lives. But a combination of treatments can help reduce symptoms.What is a gatekeeper DID? ›
Gatekeeper: A gatekeeper is an alter that controls switching or access to front, access to an internal world or certain areas within it, or access to certain alters or memories.What does a new alter feel like? ›
Another person described the experience of alters as feeling like being on a bus full of people; sometimes it's loud and scary, while other times it's quiet and calm. It's always an interesting experience.What is a protector alter? ›
Protector alters try to manage rage and anger, and avoid feelings of hurt, fear or shame. They focus on perceived threats, and find dependence , emotional needs and close relationships (attachment) threatening.Can two personalities merge? ›
It does happen! People are able to integrate their dissociated personalities that have been separate for a very long time behind an amnestic curtain. And true, it takes many years in psychotherapy with a skilled clinician for this process to complete itself thoroughly.Can people with multiple personalities switch? ›
What Is Switching? People with dissociative identity disorder have at least two distinctly different identities, but some believe as many as 100 can emerge. 3 Switching is the process of shifting from one identity state to another. This can occur slowly, with obvious signs, or very fast.
Do alternate personalities ever disappear? ›
Can dissociative disorders go away without treatment? They can, but they usually do not. Typically those with dissociative identity disorder experience symptoms for six years or more before being correctly diagnosed and treated.Is there a mild form of DID? ›
Examples of mild, common dissociation include daydreaming, highway hypnosis or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one's immediate surroundings.What does having OSDD feel like? ›
Conversion and somatoform types of dissociation may also occur in people with DID or DDNOS/OSDD. Thus, they may experience physical symptoms affecting their sensory or motor functions for which no physical cause in the present can be identified – e.g. blindness, deafness, mutism, paralysis, pain, seizures.What is splitting DID OSDD? ›
Splitting is the act of creating a new alter in dissociative identity disorder (DID) or other specified dissociative disorder (OSDD-1). There are conflicting theories as to how this occurs, neither of which alone adequately describes all types of splitting but the combination of which does.Can you fuse personalities DID? ›
While there is no absolute cure for dissociative identity disorder (DID), therapy can reduce your symptoms and improve your quality of life. DID is a rare condition where you have two or more distinct personality states. The symptoms are often lifelong, but treatments can help you cope.What famous people have dissociative identity disorder? ›
Famous people with dissociative identity disorder include comedienne Roseanne Barr, Adam Duritz, and retired NFL star Herschel Walker. Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues.What to do when someone with DID switches? ›
- Help them find an advocate and support them to meet with different therapists.
- Offer extra support and understanding before and after therapy sessions.
- Help them make a crisis plan if they think it would be helpful.
To qualify for the diagnosis, the person must have a disruption of identity characterized by two distinct personality states, which include alterations in behavior, memory, consciousness, cognition, and sense of self.How do I know if I'm a DID system? ›
Dissociative identity disorder
They may feel the presence of other identities, each with their own names, voices, personal histories and mannerisms. The main symptoms of DID are: memory gaps about everyday events and personal information. having several distinct identities.
Zoning out is considered a form of dissociation, but it typically falls at the mild end of the spectrum.
Does it hurt to switch alters? ›
For people with DID, switching is described as the process of changing from one alter or personality to another. People with DID have varying levels of awareness about their switching. Often people will experience some kind of physical symptom, like headaches, just before or after switching occurs.How many times do alters switch? ›
The average number is about 10. Often alters are stable over time, continuing to play specific roles in the person's life for years. Some alters may harbor aggressive tendencies, directed toward individuals in the person's environment or toward other alters within the person.How long does it take for alters to switch DID? ›
Transition from one personality to another is referred to as “switching.” This usually occurs within seconds to minutes, but can also be gradual, taking hours or days to complete. This is rarer.What type of childhood trauma causes dissociation? ›
PTSD and Dissociation
Dissociative disorders usually result from trauma and stress in childhood, not adulthood. They stem from chronic trauma (for example, repeated episodes of physical, emotional, or sexual abuse).
Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to long-term physical, sexual or emotional abuse or, less often, a home environment that's frightening or highly unpredictable.Does everyone with DID have memory gaps? ›
People with DID will experience gaps in memory of every day events, personal information and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms.What are apparently normal parts in DID? ›
Apparently normal parts (ANP) are the rational, present-oriented, and grounded parts of the individual that handle daily life or, in the case of dissociative identity disorder (DID) and so multiple ANP, aspects of daily life.Can you tell someone they have DID? ›
They may tell only their family or no one at all. Some choose to share their dissociative identity disorder diagnosis not just with family but also friends. I belong to a smaller group of people who publicly say, "I have DID." What's comfortable for you may be unhealthy for someone else, and vice versa.Do people with DID have a primary personality? ›
With DID, there are two or more personalities (or identities) in one person. The main personality is known as the "host." The personalities can take over at different times. They may make you act very differently. That can make it hard for you to remember things that happen when another personality was in charge.Can you develop DID out of nowhere? ›
People of any age, ethnicity, gender, and social background can develop DID, but the most significant risk factor is physical, emotional, or sexual abuse during childhood. Dissociation, or detaching from reality, can be a way of shielding the main personality from a painful mental or physical experience.
At what age do you develop DID? ›
As many as 99% of people who develop Dissociative Disorders have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine).Can you live a normal life with DID? ›
If they can learn to work together and constructively integrate their dissociations, life can be manageable and even fulfilling. When someone has DID—like many other severe mental disorders—the journey of recovery is a lifelong process. But that doesn't mean they can't live a whole, purposeful life.Can you get DID without trauma? ›
It doesn't have to have been caused by a traumatic or stressful event. Many people think that this disorder might be more common than previously thought.Can you get over DID? ›
Can I recover from a dissociative disorder? Yes - if you have the right diagnosis and treatment, there is a good chance you will recover. This might mean that you stop experiencing dissociative symptoms and any separate parts of your identity merge to become one sense of self.What happens to the brain with DID? ›
Other brain imaging studies involving people with DID show smaller brain volume in the hippocampus (an area involved in memory and learning), as well as in the amygdala (an area involved in emotional and fear response).What medication is best for dissociation? ›
Studies show that a combination of selective serotonin reuptake inhibitors (SSRI), a specific kind of antidepressant medication, and lamotrigine, an anticonvulsant and mood stabilizer, is an effective treatment for dissociative disorders, especially depersonalization-derealization disorder.What are the 5 types of dissociation? ›
There are five main ways in which the dissociation of psychological processes changes the way a person experiences living: depersonalization, derealization, amnesia, identity confusion, and identity alteration.Do DID personalities share memories? ›
Do DID personalities share memories? For years it has been assumed that people with DID have separate memory systems for each identity. However, recent research shows that this is not the case – the patients definitely have knowledge about a different identity, even if they do not experience it as such.Do alters know they are part of a system? ›
While the host is aware of the person's body, the alters are not always aware that they share the same body as the host, which can lead to belief that suicide would have no effect on the host.How do alters in DID differ from each other? ›
The different identities, referred to as alters, may exhibit differences in speech, mannerisms, attitudes, thoughts and gender orientation. The alters may even present physical differences, such as allergies, right-or-left handedness or the need for eyeglass prescriptions.
Can personalities in DID disappear? ›
The personalities are usually very different and can be any age including infancy. Symptoms of Dissociative Identity Disorder do not disappear on their own and can change in severity over the lifetime of the sufferer.Can you stop an alter from fronting? ›
Yes. This is a function primarily portrayed by what are known as “gatekeepers,” although in some circumstances it can also be done by other alter types. It's actually normal and common for gatekeeper alters to keep other certain alters from fronting.How do DID alters get their names? ›
The names of the alters often have a symbolic meaning. For example, Melody might be the name of a personality who expresses herself through music. Or the personality could be given the name of its function, such as “The Protector” or “The Perpetrator”.How do you recognize alters? ›
- different ages, for instance much younger or older;
- a different gender to the physical body;
- different names, or no name;
- different roles or functions, either related to daily life or to trauma;
- different attitudes, and preferences, e.g, in food, or dress.
Alters that take from one or more source alters as they split may have more substance or be able to quickly gain substance, but many new splits at first feel disoriented, depersonalized, hollow, flat, or incomplete.What is a fictive alter? ›
fictives are alters that are or are based off of fictional people or characters. fictives, while they already come from a media, can also have IRLs of different characters from different sources(but they dont have to) Oliver. November, 22 2021 at 7:59 pm.What is a persecutor alter DID? ›
What Is a Persecutory Alter in DID? A persecutory alter is another name for an alter that persecutes the host and/or the system. It is an alter that mistreats, controls, and oppresses a DID system in an effort to create, manipulate, and coerce a desired behavior.What kind of trauma causes DID? ›
The main cause of DID is believed to be severe and prolonged trauma experienced during childhood, including emotional, physical or sexual abuse.DID with only one alter? ›
✘ Myth: People with DID only have a few alters.
Some can only have a couple or a few, but it's more common to be around the teens. It's also extremely common to only be aware of a few for some time, and then discover many many more as therapy progresses and it is safe for them to be known by the others.
Subsystems are systems within systems. There are two main types of subsystems. The first refers to separate internal groups within one larger system. In this case, two or more groups of alters might have developed separately, and they may or may not be aware of the other group(s).